Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

Clinical Ophthalmology, May 2018

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents Danny Siu-Chun Ng,1 Zihan Sun,1 Alvin Lerrmann Young,1,2 Simon Tak-Chuen Ko,3 Jerry Ka-Hing Lok,1 Timothy Yuk-Yau Lai,1 Shameema Sikder,4 Clement C Tham1 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 2Department of Ophthalmology, Prince of Wales Hospital, 3Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, People’s Republic of China; 4Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA Objective: To identify residents’ perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions. Design: The ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann–Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (>90%) without supervisor’s intervention, and 3) prior simulation training. Setting: The study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong. Results: Of the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75, P = 0.03; capsulorrhexis completion 3.31 vs 4.40, P = 0.02; and nucleus rotation/manipulation 3.00 vs 4.75, P = 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks. Conclusion: Residents who had completed Eyesi simulation training had higher confidence in performing the most difficult tasks perceived during phacoemulsification. Keywords: virtual reality, simulation surgical education, cataract surgery

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Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

Clinical Ophthalmology impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents 0 Department of Ophthalmology, Tung Wah eastern h ospital, h ong Kong , People's republic of China 1 Department of Ophthalmology, Prince of Wales hospital 2 Department of Ophthalmology and Visual s ciences, The Chinese University of hong Kong 3 Wilmer eye institute, Johns hopkins University , Baltimore, MD, Usa , USA PowerdbyTCPDF(ww.tcpdf.org) Objective: To identify residents' perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions. Design: The ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann-Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (.90%) without supervisor's intervention, and 3) prior simulation training. Setting: The study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong. Results: Of the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75, P = 0.03; capsulorrhexis completion 3.31 vs 4.40, P = 0.02; and nucleus rotation/manipulation 3.00 vs 4.75, P = 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks. Conclusion: Residents who had completed Eyesi simulation training had higher confidence in performing the most difficult tasks perceived during phacoemulsification. The global number of blindness due to cataract has increased from 12.3 million in 1990 Clinical Ophthalmology 2018:12 885-893 885 © 2018 Ng et al. This work is published and licensed by Dove Medical Press Limited. The ful terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). virtual reality; simulation surgical education; cataract surgery - .vdo lsue w a /ww sno / r : ttsph ropeF open access to scientific and medical research O r i g i n a l r e s e a r C h Danny siu-Chun n g1 Zihan sun 1 alvin lerrmann Young 1,2 simon Tak-Chuen Ko 3 Jerr y Ka-hing lok 1 Timothy Yuk-Yau lai 1 shameema sikder 4 Clement C Tham1 Introduction to 20 million in 2010 .1,2 In East Asia, including Hong Kong, cataract is the leading cause of blindness and visual impairment in the pooled data of population-based studies.3,4 Various initiatives have been undertaken in response to fight the cataract epidemic in Hong Kong, including implementation of key performance indicator based on the waiting time for cataract surgery in public hospitals and subsidization for cataract surgery in public–private partnership programs. As a result, the average waiting time for cataract surgery in public hospitals has markedly reduced approximately threefold, from over 44 months before 2008 to 15 months after 2013.5 As physicians have pledged to keep shortening the waiting time, the demand for cataract surgeries will continue to be relentless. Alongside the rising demand for cataract surgeries, there is a constant influx of ophthalmic residents. Learning to competently perform phacoemulsification is one of their top training priorities. Traditionally, residents learned pha108 coemulsification based on the Halsted apprenticeship model,6 l-2u in which they perform the techniques step by step on actual -J12 patients under the close supervision of an attending physician. .315no 2A.0w%idteo r1a4n.7g (...truncated)


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Danny Siu-Chun Ng, Zihan Sun, Alvin Lerrmann Young, Simon Tak-Chuen Ko, Jerry Ka-Hing Lok, Timothy Yuk-Yau Lai, Shameema Sikder, Clement C Tham. Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents, Clinical Ophthalmology, 2018, pp. 885-893, DOI: 10.2147/OPTH.S140411